Appendix 1 - Nicotine Replacement Therapy (NRT)

Does the patient want to stop smoking?

• YES: Refer to Quit Your Way on TrakCare for assessment, NRT prescription advice and further support. 

• NO: Provide Quit Your Way information and advise on the benefits of stopping smoking and health risks of continued smoking. Assess whether the patient needs symptomatic relief for acute nicotine withdrawal (taking acute confusion into account) and prescribe as below.

Symptomatic relief for acute nicotine withdrawal

Prescribe Nicotinell^® patch:

• If >20 cigarettes/day smoked – 21mg patch
• If <20 cigarettes/day smoked – 14mg patch

The manufacturer recommends 24 hour use of the patch to avoid morning cravings but it can be used for 16 hours to avoid sleep disturbance. Add order note as "Note to Prescriber" on HEPMA "For Acute Withdrawal only" and review need daily.

Additional prescribing considerations

• Guidance on psychotropic drugs affected by changes in smoking status, can be found here (link only active if accessing via NHS network).
• Ensure supply of 1 week of NRT requested on discharge for patients on the stop smoking programme via Quit Your Way. And ensure follow-up support organised via Quit Your Way.
• If NRT prescribed during hospital stay for symptomatic relief and patient does not wish to stop smoking, discontinue prescription on discharge. If patient now wishes to make a quit attempt, refer to Quit Your Way before discharge via TrakCare.

Special populations

Pregnant women should be referred to Quit Your Way via Badgernet.

Quit Your Way Team Input

1. Assess patient's motivation to stop smoking.
2. Assess nicotine dependence.
3. Discuss suitability for NRT and initiate via prescribing staff.
4. Continue to monitor and support patient for length of hospital stay.
5. As part of patient discharge plan, arrange follow-up support by referring to community stop smoking service for NRT for up to 12 weeks.